Effective Date: Sept.1, 2026

Health Plans Affected: Advantage MD, Employer Health Programs (EHP), Priority Partners, US Family Health Plan (USFHP)

Type of Change: Authorization Requirements Status

Explanation of Change:

Authorization status changes, effective Sept. 1, 2026, have been confirmed. These requirements affect members of all ages enrolled in Johns Hopkins Health Plans.

Key: PA=Prior Authorization Required; NPA=No Prior Authorization Required; NC (Not Covered); NC I&E (Not Covered Investigative & Experimental)

Advantage MD Code Changes

• L5783 - Addition to lower extremity, user adjustable, mechanical, residual limb volume management system; PA
• 97550 - Caregiver training strategies and techniques first 30 min; PA
• 97551 - Caregiver training strategies and techniques each additional 15 min; PA
• 97552 - Group caregiver training strategies and techniques; PA
• 62330 - Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (i.e., CT or fluoroscopy), bilateral; one interspace, lumbar; PA as per EviCore
• 62331 - Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (i.e., CT or fluoroscopy), bilateral; additional interspace(s), lumbar (List separately in addition to code for primary procedure); PA as per EviCore

EHP Code Changes

• L5783 - Addition to lower extremity, user adjustable, mechanical, residual limb volume management system; NPA

Priority Partners Code Changes

• 59866 - Multifetal pregnancy reduction; NC responsibility of MD Medicaid
• G0499 - Hepatitis B screening; NC not on state fee schedule
• G0153 - Services by a speech-language pathologist in the home, each 15 min; PA
• E0657 - Segmental pneumatic appliance; NC not on state fee schedule
• 76999 - Unlisted ultrasound procedure; PA
• 77799 - Unlisted procedure, clinical brachytherapy; PA
• 78099 - Unlisted endocrine procedure, dx nuclear med; PA
• 78299 - Unlisted gastrointestinal procedure, dx nuclear med; PA
• 78599 - Unlisted respiratory procedure, dx nuclear med; PA
• 78799 - Unlisted genitourinary procedure, dx nuclear med; PA
• 79999 - Radiopharmaceutical therapy, unlisted procedure; PA

USFHP Code Changes

• L5783 - Addition to lower extremity, user adjustable, mechanical, residual limb volume management system; PA
• 97550 - Caregiver training strategies and techniques first 30 min; PA
• 97551 - Caregiver training strategies and techniques each additional 15 min; PA
• 97552 - Group caregiver training strategies and technique; PA

Prior Authorization Process

• Advantage MD, EHP and Priority Partners: Please use our secure online portal, Availity, to submit electronic prior authorization requests.
• USFHP: Submit prior authorization requests to the Johns Hopkins Health Plans Utilization Management (UM) department using the se dedicated fax numbers: 410-424-2602 or 410-424-2603 until Aug. 15, 2026. After that date, please use the Availity portal.